The leading cause of death in women is heart disease, but doctors often attribute women’s symptoms to anxiety, according to a new study presented to the Transcatheter Cardiovascular Therapeutics meeting in Washington. The researchers said the study may explain why women frequently fail to receive prompt treatment for heart problems.

According to the study, when doctors examine patients who are stressed out and exhibit symptoms of heart disease, they are more prone to attribute the symptoms to anxiety if the patient is a woman. If patients show symptoms of heart disease but do not complain of recent and specific stress, they are more likely to receive a correct diagnosis.

The research involved doctors reading case histories of men and women with similar risks of heart disease. When the history said the patient exhibited anxiety and reported stress in their lives, doctors interpreted symptoms such as chest pain as being psychological rather than physical more than twice as often when the patient was a woman.

The researchers said that since women are more likely than men to discuss stress with their doctors, and since women don’t always exhibit symptoms of heart disease such as chest pain, doctors need to be aware of gender bias when making a diagnosis.